Imagine you are 7 months pregnant. Now imagine that you think your water is broken, but you are not totally sure. So you go to your prenatal group visit and wonder whether or not you should say something. You do. But you don’t make a huge deal of it and your medical provider does not seem worried. Then you get an exam after the group visit and your medical provider confirms that your water is broken. And you are currently still two months before your due date. How do you feel? You might be freaking out. Or completely numb. Perhaps strangely calm.
Premature birth happens quite a lot, so much so that I might be a bit desensitized to it from my work as a nurse. This undesirable outcome, babies arriving in the world too early, is a result of many factors. It is also a symptom of the systemic oppression that exists in our modern world. Black and indigenous people have a premature birth rate of up to 49% higher than the premature birth rate among all other groups (according to the most recent data I could find by March of Dimes). That number blows my mind. And I am used to swimming in the grief of seeing this statistic play out all the time as much as I try to change it. The chronic cumulative effects of living in an unjust and racist world play out in health outcomes and birth outcomes alike. This oppressive messaging gets internalized and convinces you that your voice does not matter. So then you don’t speak up or speak up as loudly as you would otherwise. This is how you end up sitting in a puddle of amniotic fluid on an exam table while your medical provider tells you to that your water is broken and your might deliver your baby two months early.
Even when you do speak up for yourself in pregnancy or simply in a medical setting, you may not be heard as in the case of Serena Williams. She had potentially deadly post-partum blood clots that her medical providers missed. She only got an evaluation after much insistence on her part. Why the hell did she need to press so hard to get the care she needed? And she is SERENA FREAKING WILLIAMS! She had to use a bullhorn for the nearly deaf medical providers to listen to her intuition about her own body. She knew something was not right and said so repeatedly. The racial and gender biases present in the medical system failed her and nearly killed her. If she was not such a powerful public figure with abundant financial resources, I think her body would not have survived the ordeal.
I know this power dynamic from the other side as well. Clients call me “doctora” all the time at my clinic. I have stopped trying to correct the technically incorrect association. I am a nurse, not a doctor. Nor am I anyone’s savior for that matter. I take issue not with this very humbling display of respect, but with the idea that I am “better than” in some way. The word “doctora” insinuates that I am an all knowing healer, that you should trust my judgement before you trust your own. And THAT is a load of hooey. That load of hooey is exactly what almost killed Serena Williams. It is what made the 7-month pregnant person sit in a puddle of amniotic fluid (a true story, by the way) because she doubted her ability to know when something was amiss in her body. Or perhaps more accurately, she thought no one would take her concerns seriously.
On the flip side of this issue, there are other people who feel so powerless in their own lives that the only thing they feel they can do is act out. So they speak up with violent vocal tone and body language, threats, or physical violence. This happened just last week at my clinic where an older white man felt so unheard that he violently threatened staff at the clinic. I have also seen a few pregnant women act in threatening ways at the clinic, though much more frequently I see systemic racism and other oppressions manifest as a lack of expression of one's needs. If people are shown time and again how futile speaking up can be in a medical (or nearly any) setting, they either choose to stay silent or risk feeling like they are yelling in the forest with no one around who can hear them.
So what do we do with this information? I am not inclined to shun those who commit violent acts from society and isolate them. That is often what is at the root of their violent behaviors in the first place, lacking a sense of belonging from a very young age. Which is not to say that we do not need to protect ourselves from violence, that is absolutely necessary. What I AM saying is that we need to prevent this type of explosive behavior by being inclusive. By raising our children not to tease others for their perceived “otherness”. To have rehabilitation programs that get at the origin of the urge to act out violently. That is where the real healing is.
When we stop shutting people out and start welcoming them with love and FIRM boundaries, beautiful things can happen. I have seen this work miraculously with pregnant patients who have been disruptive in clinic while engaging in destructive and at times violent behaviors in their lives. I have seen people with the most horrific trauma history struggling with addiction, depression, PTSD, and violent behaviors who ultimately turn their lives around because of a new baby on the way and the flow of support they receive from others in their personal lives and from clinic staff.
The challenge of speaking up for ourselves is something that is often learned the hard way. Being the person standing up for your needs or the needs of others can lead to being ostracized or worse threatened with violence for breaking the silence. All of us have had the experience of not feeling heard. This might cause us to act out with anger or get very quiet out of doubt and fear of being rejected.
Setting clear and firm boundaries protects and nourishes stronger relationships with ourselves and with our communities. Start by setting boundaries with yourself. Start holding yourself accountable to your own desires and to your joy. This is deeply radical work. The oppressions of the modern world will try to keep you from doing this work. We must be steadfast and constant in our resolve to listen to our bodies and our needs. Consider how you listen to your body. Then consider how you might use your power to amplify the voices of others. As a health care professional, my work is to deconstruct my unearned power and privilege such that people who need medical care feel increased freedom to advocate for themselves. This collective healing work will ultimately lead to better health outcomes for all, including a decrease in the high rates of premature birth among oppressed groups.
There are so many examples of people who could not or would not listen to others because they were either not taught how to listen to themselves or actively discouraged from doing so. So listen to your body. Really listen. Repeat daily or every five minutes as needed. This prescription is refillable indefinitely.